From the Guidelines
The treatment for perocular dermatitis should prioritize discontinuing all topical steroids and avoiding greasy creams, with a focus on gentle skincare and potentially topical antibiotics. When managing perocular dermatitis, it is crucial to avoid treatments that could exacerbate the condition, such as greasy creams for basic care, manipulation of the skin, and topical steroidsa, as they may cause perioral dermatitis and skin atrophy if used inadequately 1.
Key Considerations
- Discontinuation of topical steroids is essential, as they can worsen the condition or be the initial cause.
- Avoidance of greasy creams and heavy moisturizers around the eyes is recommended.
- Simplifying the skincare routine and using gentle, fragrance-free cleansers can help alleviate symptoms.
- Topical antibiotics such as metronidazole or erythromycin may be beneficial in managing the condition.
- Oral antibiotics like doxycycline may be considered for more severe cases.
Treatment Approach
The approach to treating perocular dermatitis involves a combination of topical and, if necessary, oral medications, alongside lifestyle modifications to reduce irritants and simplify skincare.
- Topical antibiotics can be applied twice daily for 4-8 weeks.
- Oral antibiotics may be prescribed for 4-12 weeks in more severe cases.
- Skincare routines should be simplified, focusing on gentle, fragrance-free products and avoiding potential irritants.
Mechanism and Outcome
The treatment works by addressing both the bacterial component and the inflammatory response characteristic of perocular dermatitis, leading to improvement within 2-4 weeks and potential complete resolution in several months. It's essential to manage patient expectations and advise them that the condition may temporarily worsen after discontinuing topical steroids before improving with appropriate treatment, as supported by the principles outlined in 1.
From the Research
Treatment for Perocular Dermatitis
The treatment for perocular dermatitis is similar to that of perioral dermatitis, with a focus on eliminating exacerbating factors and using topical or oral medications to reduce symptoms.
- Discontinuing the use of topical fluorinated corticosteroids and other exacerbating products is often the first step in treatment, as seen in studies 2 and 3.
- Topical metronidazole, oral tetracycline, and topical erythromycin have been shown to be effective in treating perioral dermatitis, and may also be used to treat perocular dermatitis 4 and 5.
- Calcineurin inhibitors, such as pimecrolimus, may also be effective in treating periocular eczematous lesions, although they are not approved for this specific use 6.
- In some cases, a "zero therapy" approach, where all topical products are discontinued, may be effective in clearing up the condition 4 and 3.
Specific Treatment Options
- Oral tetracyclines have been shown to be effective in reducing the time to papule resolution in perioral dermatitis, and may also be used to treat perocular dermatitis 4 and 2.
- Topical pimecrolimus has been shown to rapidly reduce the severity of perioral dermatitis, particularly in patients who have previously used topical corticosteroids 4.
- Topical metronidazole may be used to treat perioral dermatitis in children, although the evidence supporting its use is relatively weak 4 and 5.